Anxiety mefloquine

Mefloquine (oral) 228 mg (base) (250 mg salt) weekly Less than or equal to 15 kg 4.6 mg/kg base (5 mg/kg salt) once weekly 1 5-19 kg 1/4 tablet 20-30 kg 1/f tablet 31-45 kg 3A tablet Greater than or equal to 45 kg 1 tablet Start 1 -2 wk before departure and continue for 4 wk after leaving endemic area may start 3—4 wk earlier to assess tolerance Contraindications History of seizure, psychiatric disorders (including depression and anxiety), or arrhythmias... 

While its detailed mechanism of action is unknown, it is an effective blood schizonticide that is, it acts against the form of the parasite responsible for chnical symptoms. Orally administered mefloquine is well absorbed and has an absorption half-hfe of about 2 hours the elimination half-hfe is 2 to 3 weeks. Among its side effects are vertigo, visual alterations, vomiting, and such CNS disturbances as psychosis, hallucinations, confusion, anxiety, and depression. It should not be used concurrently with compounds known to alter cardiac conduction or prophylactically in patients operating dangerous machinery. It should not used to treat severe malaria, as there is no intravenous formulation. 

Adverse reactions include nausea, vomiting, dizziness, diarrhoea, abdominal pain, anxiety disorder, sinus bradycardia, ataxia. It is reported that mefloquine is teratogenic in nature so should not be given in first trimester of pregnancy. 

A 52-year-old woman with no psychiatric history developed anxiety, paranoia, visual hallucinations, confusion, and depressive symptoms after 3 doses of prophylactic mefloquine (250 mg/week) (502). She had previously taken mefloquine prophylaxis intermittently for 4 years with no adverse events. 

A 48-year-old woman developed anxiety, tremor, depression, dry mouth, nausea, and marked weight loss (503). Physical examination, electrocardiography, chest X-ray, CT scan, and laboratory investigations were unremarkable. The Hamilton D score was 44 for 17 items. She had taken mefloquine 250 mg/week for 8 weeks for malaria prophylaxis, and after 2 weeks had started to feel unwell, with dysphoria, depression, and weakness. She was given fluoxetine 20 mg/day and alprazolam 1.5 mg/day. Her condition continued to deteriorate. The dose of fluoxetine was increased to 40 mg/day and flunitrazepam was added. She was later instead given milnacipran, a serotonin and noradrenaline reuptake... 

Nervous system The literature on mefloquine neurotoxicity has been reviewed [9 ]. Nausea, dizziness, sleep disturbances, anxiety, and psychosis have been reported. Female patients and patients with a low body mass index are at greater risk. 

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